BACKGROUND & AIMS: :In recent years, ready-to eat breakfast cereals prepared with fruit ingredients have gained particular attention due to their polyphenolic contents and health promoting effects. In this study, the matrix effect of blueberry, oat meal, whole milk or skimmed milk on polyphenols, antioxidative potential as well as their potential bioavailability were investigated. The phenolic properties of whole milk, skimmed milk, blueberry and oat meal were investigated and the changes in combinations of the ingredients were determined. Milk addition decreased the total phenolic, flavonoid and anthocyanin content of samples statistically and had negative effect on antioxidant activity showing differences among different methods. According to HPLC results, it was not possible to detect catechin in mixtures due to milk addition. In vitro digestion method was used to determine potential bioavailability of phenolic compounds. According to in vitro digestion procedure results, whole or skimmed milk did not affect the total phenolic content of the proportion passing to the blood from intestine.

背景与目标： : 近年来，以水果成分制成的即食早餐谷物因其多酚含量和促进健康的作用而受到特别关注。在这项研究中，研究了蓝莓，燕麦粉，全脂牛奶或脱脂奶对多酚的基质效应，抗氧化潜力及其潜在的生物利用度。研究了全脂牛奶，脱脂牛奶，蓝莓和燕麦粉的酚醛特性，并确定了成分组合的变化。牛奶的添加在统计学上降低了样品中总酚，类黄酮和花青素的含量，并对抗氧化活性产生负面影响，表明不同方法之间存在差异。根据HPLC结果，由于添加牛奶，无法检测混合物中的儿茶素。体外消化法用于确定酚类化合物的潜在生物利用度。根据体外消化程序的结果，全脂或脱脂牛奶不会影响从肠道传递到血液的比例的总酚含量。

BACKGROUND & AIMS: BACKGROUND:Pharmacokinetic data for lopinavir in late pregnancy and in breastfeeding are limited, and no data for abacavir in breast milk are available. METHODS:Women in the Mma Bana Study initiated HAART from 18 to 34 weeks of gestation. We determined trough plasma and whole breast milk concentrations of lopinavir (LPV), abacavir (ABC), nevirapine (NVP), lamivudine (3TC) and zidovudine (ZDV) among separate subsets of pregnant and breastfeeding women, and in plasma of exposed infants. Lopinavir was measured 1 month after starting HAART or 1 month postpartum, and other drugs were measured 1 month postpartum. RESULTS:Sampling occurred a median of 14 h (range 11-17) from last maternal drug ingestion. Although 50% higher median LPV levels were seen in postpartum than antepartum plasma (8.29 μg/ml versus 5.51 μg/ml; P = 0.02), antepartum levels with standard LPV dosing were therapeutic for all women (> 1.0 μg/ml). Very low LPV levels (< 0.25 μg/ml) were detected in breast milk. Median ABC levels in breast milk were 85% of those in plasma (0.057 μg/ml versus 0.067 μg/ml). Breast milk concentrations of NVP and 3TC were 27% and 74% of plasma levels, respectively. At these trough maternal time points, only NVP was detectable in potentially inhibitory levels in breastfeeding infants, and most infants had non-detectable levels of LPV, ABC, ZDV and 3TC via maternal breast milk. CONCLUSIONS:Standard LPV dosing achieved therapeutic levels in pregnancy and no appreciable concentrations in breast milk. ABC is detectable in breast milk at similar concentrations to plasma, but does not result in appreciable infant exposure.

背景与目标：

BACKGROUND & AIMS: :Although the processes of climate change are not completely understood, an important causal candidate is variation in total solar output. Reported cycles in various climate-proxy data show a tendency to emulate a fundamental harmonic sequence of a basic solar-cycle length (11 years) multiplied by 2(N) (where N equals a positive or negative integer). A simple additive model for total solar-output variations was developed by superimposing a progression of fundamental harmonic cycles with slightly increasing amplitudes. The timeline of the model was calibrated to the Pleistocene/Holocene boundary at 9,000 years before present. The calibrated model was compared with geophysical, archaeological, and historical evidence of warm or cold climates during the Holocene. The evidence of periods of several centuries of cooler climates worldwide called "little ice ages," similar to the period anno Domini (A.D.) 1280-1860 and reoccurring approximately every 1,300 years, corresponds well with fluctuations in modeled solar output. A more detailed examination of the climate sensitive history of the last 1, 000 years further supports the model. Extrapolation of the model into the future suggests a gradual cooling during the next few centuries with intermittent minor warmups and a return to near little-ice-age conditions within the next 500 years. This cool period then may be followed approximately 1,500 years from now by a return to altithermal conditions similar to the previous Holocene Maximum.

背景与目标： : 尽管尚未完全了解气候变化的过程，但重要的因果关系是太阳能总产量的变化。各种气候代理数据中报告的周期显示出一种趋势，即模拟基本太阳周期长度 (11年) 乘以2(N) (其中N等于正整数或负整数) 的基本谐波序列。通过叠加振幅略有增加的基本谐波周期的级数，开发了一种简单的总太阳能输出变化的附加模型。该模型的时间线已校准为距今9,000年的更新世/全新世边界。将校准后的模型与全新世期间温暖或寒冷气候的地球物理，考古和历史证据进行了比较。世界范围内几个世纪的凉爽气候时期的证据称为 “小冰期”，类似于anno Domini (公元) 时期。1280 1860并大约每1,300年重复发生一次，与模拟太阳能输出的波动非常吻合。对过去1000年的气候敏感历史进行更详细的检查进一步支持了该模型。从模型到未来的推断表明，在接下来的几个世纪中，将逐渐冷却，并间歇性地进行较小的预热，并在接下来的500年内恢复到接近小冰期的条件。然后，从现在起大约1,500年后，可以恢复到类似于先前全新世最大值的高热条件。

BACKGROUND & AIMS: BACKGROUND:Bioreactance estimates cardiac output in a non-invasive way. We evaluated the ability of a bioreactance device (NICOM®) to estimate cardiac index (CI) and to track relative changes induced by volume expansion. METHODS:In 48 critically ill patients, we measured CI estimated by the NICOM® device (CINicom) and by transpulmonary thermodilution (CItd, PiCCO2™ device) before and after a 500 ml saline infusion. Before volume expansion, we performed a passive leg raising (PLR) test and measured the changes it induced in CINicom and in pulse contour analysis-derived CI. RESULTS:Considering the values recorded before PLR and before and after volume expansion (n=144), the bias (lower and upper limits of agreement) between CItd and CINicom was 0.9 (-2.2 to 4.1) litre min(-1) m(-2). The percentage error was 82%. There was no significant correlation between the changes in CItd and CINicom induced by volume expansion (P=0.24). An increase in CI estimated by pulse contour analysis >9% during the PLR test predicted fluid responsiveness with a sensitivity of 84% (95% confidence interval 60-97%) and a specificity of 97% (95% confidence interval 82-100%). The area under the receiver operating characteristic curve constructed to test the ability of the PLR-induced changes in CINicom in predicting fluid responsiveness did not differ significantly from 0.5 (P=0.77). CONCLUSIONS:The NICOM® device cannot accurately estimate the cardiac output in critically ill patients. Moreover, it could not predict fluid responsiveness through the PLR test.

背景与目标：

BACKGROUND & AIMS: :Because iodine is added to cattle feed, milk and dairy products have become a major source of dietary iodine in Britain. The mean iodine concentrations of milk supplied to seven towns in England were measured each month throughout 1 year. Values were more than twice those recorded 20 years ago. There were large differences between the towns, with average annual concentrations ranging from 130 to 200 micrograms/l. Within the towns there were up to four-fold variations between the peak values in February/March and lowest values in June. The similarity between the monthly variations in milk iodine and seasonality in the onset of thyrotoxicosis suggests that iodine concentrations in milk and dairy products may now have reached harmful levels. Control of high winter levels in areas of Britain which were previously iodine deficient may now be necessary.

背景与目标： : 由于牛饲料中添加了碘，牛奶和乳制品已成为英国饮食碘的主要来源。在一年中，每月测量提供给英格兰七个城镇的牛奶的平均碘浓度。价值是20年前记录的两倍多。城镇之间差异很大，年平均浓度范围为130至200微克/升。在城镇内，2月/3月的峰值与6月的最低值之间的变化高达四倍。牛奶碘的每月变化与甲状腺毒症发作的季节性之间的相似性表明，牛奶和乳制品中的碘浓度现在可能已达到有害水平。现在可能有必要控制以前缺碘的英国地区的高冬季水平。

BACKGROUND & AIMS: :Subclinical mastitis by Staphylococcus aureus (SAU) and by non-aureus staphylococci (NAS) is a major issue in the water buffalo. To understand its impact on milk, 6 quarter samples with >3,000,000 cells/mL (3 SAU-positive and 3 NAS-positive) and 6 culture-negative quarter samples with <50,000 cells/mL were investigated by shotgun proteomics and label-free quantitation. A total of 1530 proteins were identified, of which 152 were significantly changed. SAU was more impacting, with 162 vs 127 differential proteins and higher abundance changes (P < 0.0005). The 119 increased proteins had mostly structural (n = 43, 28.29%) or innate immune defence functions (n = 39, 25.66%) and included vimentin, cathelicidins, histones, S100 and neutrophil granule proteins, haptoglobin, and lysozyme. The 33 decreased proteins were mainly involved in lipid metabolism (n = 13, 59.10%) and included butyrophilin, xanthine dehydrogenase/oxidase, and lipid biosynthetic enzymes. The same biological processes were significantly affected also upon STRING analysis. Cathelicidins were the most increased family, as confirmed by western immunoblotting, with a stronger reactivity in SAU mastitis. S100A8 and haptoglobin were also validated by western immunoblotting. In conclusion, we generated a detailed buffalo milk protein dataset and defined the changes occurring in SAU and NAS mastitis, with potential for improving detection (ProteomeXchange identifier PXD012355).

背景与目标： : 金黄色葡萄球菌 (SAU) 和非金黄色葡萄球菌 (NAS) 引起的亚临床乳腺炎是水牛中的主要问题。为了了解其对牛奶的影响，通过shot弹枪蛋白质组学和无标记定量研究了6个具有> 3,000,000个细胞/mL的四分之一样品 (3个SAU阳性和3个NAS阳性) 和6个具有 <50,000个细胞/mL的培养阴性四分之一样品。共鉴定出1530种蛋白质，其中152种发生了显著变化。SAU的影响更大，162与127差异蛋白和更高的丰度变化 (p  <  0.0005)。119增加的蛋白质主要具有结构 (n   =   43，28.29%) 或先天免疫防御功能 (n   =   39，25.66%)，包括波形蛋白，cathelicidins，组蛋白，S100和中性粒细胞颗粒蛋白，触珠蛋白和溶菌酶。33个减少的蛋白质主要参与脂质代谢 (n   =   13，59.10%)，包括嗜丁蛋白，黄嘌呤脱氢酶/氧化酶和脂质生物合成酶。字符串分析也对相同的生物学过程产生了显着影响。西方免疫印迹证实，Cathelicidins是增加最多的家族，在SAU乳腺炎中具有更强的反应性。S100A8和触珠蛋白也通过western免疫印迹验证。总之，我们生成了详细的水牛牛奶蛋白数据集，并定义了SAU和NAS乳腺炎中发生的变化，具有改善检测的潜力 (蛋白质交换标识符PXD012355)。

BACKGROUND & AIMS: :On November 27, 2007, a local health officer in central Massachusetts contacted the Massachusetts Department of Public Health (MDPH) to report listeriosis in a man aged 87 years. Pulsed-field gel electrophoresis (PFGE) performed on the patient's Listeria monocytogenes isolate produced a pattern indistinguishable from that of isolates from three other cases identified in residents of central Massachusetts in June, October, and early November 2007. MDPH, in collaboration with local public health officials, conducted an investigation, which implicated pasteurized, flavored and nonflavored, fluid milk produced by a local dairy (dairy A) as the source of the outbreak. This report summarizes the results of that investigation. In all, five cases were identified, and three deaths occurred. This outbreak illustrates the potential for contamination of fluid milk products after pasteurization and the difficulty in detecting outbreaks of L. monocytogenes infections.

背景与目标： : 2007年11月27日，马萨诸塞州中部的一名当地卫生官员联系了马萨诸塞州公共卫生部 (MDPH)，报告了一名87岁男子的李斯特菌病。对患者的单核细胞增生李斯特菌分离株进行的脉冲场凝胶电泳 (PFGE) 产生的模式与6月，10月和2007年11月早期在马萨诸塞州中部居民中发现的其他三例分离株的模式无法区分。MDPH与当地公共卫生官员合作进行了一项调查，该调查涉及当地乳制品 (dairy a) 生产的巴氏杀菌，调味和非调味的流质牛奶是爆发的源头。本报告总结了调查结果。共发现5例病例，3例死亡。这次爆发说明了巴氏消毒后液体奶制品可能受到污染，并且很难检测到单核细胞增生李氏杆菌感染的爆发。

BACKGROUND & AIMS: :To determine whether PTH and calcium (Ca) interact in neonatal bone formation, female lactating mice either heterozygous (PTH(+/-)) or homozygous (PTH(-/-)) for targeted deletion of the pth gene were fed either a normal (1% Ca, 0.6% phosphate) or high-Ca diet (2% Ca and 0.4% phosphate). Dietary effects on milk Ca content and Ca-regulating hormones were determined in dams, and the effects of milk content were assessed on bone turnover in 3-wk-old pups. On the normal diet, milk Ca and 1,25-dihydroxyvitamin D(3) levels were lower, but milk PTH-related protein levels were higher in the PTH(-/-) dams compared with the PTH(+/-) dams. On the high-Ca diet, milk Ca levels were higher, but milk 1,25-dihydroxyvitamin D(3) and PTH-related protein levels were lower in both PTH(+/-) and PTH(-/-) dams. In pups fed by PTH(-/-) dams compared with pups fed by PTH(+/-) dams on normal diets, bone mineral density, trabecular bone volume relative to tissue volume, and the number of osteoblasts were reduced in both PTH(+/-) (32.5 +/- 1.2 vs. 39.6 +/- 1.5 mg/cm(2), P < 0.05; 23.3 +/- 1.6 vs. 29.2 +/- 2.8%, P < 0.01; and 94.2 +/- 8.2 vs. 123.5 +/- 3.5/mm(2), P < 0.01, respectively) and PTH(-/-) (20.4 +/- 0.9 vs. 27.0 +/- 1.2 mg/mm(2), P < 0.05; 16.8 +/- 1.9 vs. 19.3 +/- 2.1%, P < 0.05; and 48.6 +/- 7.9 vs. 90.5 +/- 8.6/mm(2), P < 0.01, respectively) pups but were lower in the PTH(-/-) pups compared with the PTH(+/-) pups. In contrast, in pups fed by either PTH(+/-) or PTH(-/-) dams on the high-Ca diet, bone mineral density, bone volume/tissue volume, and osteoblast numbers were significantly higher, in both PTH(+/-) (50.5 +/- 1.7 vs. 58.7 +/- 2.0 mg/mm(2), P < 0.05; 37.9 +/- 5.2 vs. 46.1 +/- 5.1, P < 0.05; and 120.5 +/- 9.2 vs. 159.3 +/- 14.7/mm(2), P < 0.01, respectively) and PTH(-/-) (33.0 +/- 1.2 vs. 47.5 +/- 2.2 mg/mm(2), P < 0.001; 23.8 +/- 3.1 vs. 35.9 +/- 2.0, P < 0.05; and 78.7 +/- 10.1 vs. 99.8 +/- 13.6/mm(2), P < 0.05, respectively), and were highest in the PTH(+/-) pups fed by the PTH(+/-) dams on the high-Ca diet. These results indicate that PTH can modulate Ca content of milk, and that PTH and Ca can each exert cooperative roles on osteoblastic bone formation in the neonate.

背景与目标： : 为了确定PTH和钙 (Ca) 在新生儿骨形成中是否相互作用，雌性哺乳小鼠以杂合 (PTH (/-)) 或纯合 (PTH(-/-)) 的方式靶向缺失pth基因，以正常 (1% Ca，0.6% 磷酸盐) 或高Ca饮食 (2% Ca和0.4% 磷酸盐)。在水坝中确定了饮食对牛奶Ca含量和Ca调节激素的影响，并评估了牛奶含量对3周龄幼崽骨转换的影响。在正常饮食中，与PTH (/-) 大坝相比，PTH(-/-) 大坝中的牛奶Ca和1,25-二羟基维生素d (3) 水平较低，但与PTH (/-) 大坝相比，牛奶PTH相关的蛋白质水平较高。在高Ca饮食中，PTH (/-) 和PTH(-/-) 大坝中的牛奶Ca水平较高，但牛奶1,25-二羟基维生素d (3) 和PTH相关蛋白水平较低。在正常饮食中，由PTH(-/-) 坝喂养的幼崽与由PTH (/-) 坝喂养的幼崽相比，骨矿物质密度，小梁骨体积相对于组织体积，两种PTH(+/-) 成骨细胞数量均减少 (32.5 +/- 1.2 vs. 39.6 +/- 1.5 mg/cm(2)，P <0.05; 23.3 +/- 1.6 vs. 29.2 +/- 2.8%，P <0.01; 和94.2 +/- 8.2 vs. 123.5 +/- 3.5/mm(2)，P <0.01) 和PTH(-/-) (20.4 +/- 0.9 vs. 27.0 +/- 1.2 mg/mm(2)，P <0.05; 16.8 +/- 1.9对19.3 +/- 2.1%，P <0.05; 48.6 +/- 7.9对90.5 +/- 8.6/mm(2)，P <0.01，分别) 幼崽，但与PTH (/-) 幼崽相比，PTH(-/-) 幼崽较低。相反，在高Ca饮食中，由PTH (/-) 或PTH(-/-) 大坝喂养的幼崽中，骨矿物质密度，骨体积/组织体积和成骨细胞数量显着更高，两种PTH(+/-) (50.5 +/- 1.7 vs. 58.7 +/- 2.0 mg/mm(2)，P <0.05; 37.9 +/- 5.2 vs. 46.1 +/- 5.1，P <0.05; 和120.5 +/- 9.2 vs. 159.3 +/- 14.7/mm(2)，P <0.01) 和PTH(-/-) (33.0 +/- 1.2 vs. 47.5 +/- 2.2 mg/mm(2)，P <0.001; 23.8 +/- 3.1对35.9 +/- 2.0，P <0.05; 和78.7 +/- 10.1对99.8 +/- 13.6/mm(2)，P <0.05)，在高Ca饮食中，PTH (/-) 大坝喂养的PTH (/-) 幼崽中最高。这些结果表明，PTH可以调节牛奶中的Ca含量，并且PTH和Ca可以各自对新生儿的成骨细胞骨形成发挥协同作用。

BACKGROUND & AIMS: BACKGROUND:Cardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients. METHODS:Thirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral. RESULTS:Sixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were -1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of ΔCO measurements were compared. There was a significant correlation between ΔCO-PAC and ΔCO-TTE (r = 0.92; p < 0.0001). The median bias was -0.1 L/min and the LOAs were -1.3 and +1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0° and a percentage error LOAs of -26.8 to 28.8°. The concordance rate was 100% between 30 and -30°. When using CO-TTE to detect an increase in ΔCO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62-0.94) (p < 0.001). A ΔCO-TTE of more than 8% yielded a sensitivity of 88% and specificity of 66% for detecting a ΔCO-PAC of more than 10%. CONCLUSION:In critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.

背景与目标：

BACKGROUND & AIMS: :Techniques enabling in situ monitoring of drug solubilization and changes in the solid-state of the drug during the digestion of milk and milk-based formulations are valuable for predicting the effectiveness of such formulations in improving the oral bioavailability of poorly water-soluble drugs. We have recently reported the use of low-frequency Raman scattering spectroscopy (region of analysis <200 cm-1) as an analytical approach to probe solubilization of drugs during digestion in milk using ferroquine (SSR97193) as the model compound. This study investigates the wider utilization of this technique to probe the solubilization behavior of other poorly water-soluble drugs (halofantrine, lumefantrine, and clofazimine) in not only milk but also infant formula in the absence or presence of bile salts during in vitro digestion. Multivariate analysis was used to interpret changes to the spectra related to the drug as a function of digestion time, through tracking changes in the principal component (PC) values characteristic to the drug signals. Characteristic low-frequency Raman bands for all of the drugs were evident after dispersing the solid drugs in suspension form in milk and infant formula. The drugs were generally solubilized during the digestion of the formulations as observed previously for ferroquine and correlated with behavior determined using small-angle X-ray scattering (SAXS). A greater extent of drug solubilization was also generally observed in the infant formula compared to milk. However, in the case of the drug clofazimine, the correlation between low-frequency Raman scattering and SAXS was not clear, which may arise due to background interference from clofazimine being an intense red dye, which highlights a potential limitation of this new approach. Overall, the in situ monitoring of drug solubilization in milk and milk-based formulations during digestion can be achieved using low-frequency Raman scattering spectroscopy, and the information obtained from studying this spectral region can provide better insights into drug solubilization compared to the mid-frequency Raman region.

背景与目标： 能够在消化牛奶和基于牛奶的制剂期间原位监测药物增溶和药物固态变化的技术对于预测此类制剂在改善水溶性差的药物的口服生物利用度方面的有效性很有价值。我们最近报道了使用低频拉曼散射光谱 (分析区域 <200厘米-1) 作为一种分析方法，以铁喹 (SSR97193) 作为模型化合物，在牛奶中消化过程中探测药物的增溶。这项研究调查了该技术在体外消化过程中不存在或存在胆汁盐的情况下，不仅在牛奶中，而且在婴儿配方奶粉中，还可以更广泛地利用该技术来探讨其他水溶性差的药物 (卤芬特林，卢美芬曲林和氯法齐美林) 的溶解行为。多变量分析用于通过跟踪药物信号特征的主成分 (PC) 值的变化来解释与药物相关的光谱随消化时间的变化。将固体药物以悬浮液形式分散在牛奶和婴儿配方奶粉中后，所有药物的特征性低频拉曼谱带都很明显。如先前对铁喹观察到的，药物通常在制剂的消化过程中溶解，并与使用小角度x射线散射 (SAXS) 确定的行为相关。与牛奶相比，婴儿配方奶粉通常还观察到更大程度的药物增溶。然而，在药物氯法齐明的情况下，低频拉曼散射与SAXS之间的相关性尚不清楚，这可能是由于氯法齐明是一种强烈的红色染料的背景干扰而引起的，这凸显了这种新方法的潜在局限性。总体而言，可以使用低频拉曼散射光谱来实现消化过程中牛奶和基于牛奶的制剂中药物增溶的原位监测，与中频拉曼区相比，研究该光谱区域获得的信息可以更好地洞察药物增溶。

BACKGROUND & AIMS: PURPOSE:Tolvaptan, a vasopressin V2 receptor antagonist, slows the decline in renal function in autosomal dominant polycystic kidney disease (ADPKD). However, it increases urine output such that patient adherence could be compromised. In a cohort of patients with ADPKD on tolvaptan, we aimed to identify the contribution of sodium and urea excretion rate to daily urine output, and to evaluate the effectiveness of dietary counseling on sodium and urea excretion rates. METHODS:Retrospective analysis of 30 ADPKD patients who underwent a single session of personalized dietary counseling to reduce sodium and protein intake before initiation of tolvaptan. Creatinine and 24-h urine were obtained regularly on treatment. Generalized estimation equations were used. RESULTS:Mean age and median eGFR were 44 ± 11 years and 52 (43-74) ml/min/1.73 m2. Tolvaptan increased diuresis from 2.5 to 5.2 l/day. After adjusting for the dose of tolvaptan, an increase in sodium and urea excretion rate by 50 mmol/day was associated with an estimated additional urine volume of 0.6 l/day (95% CI 0.4-0.8 l/day; P < 0.001) and 0.25 l/day (95% CI 0.11-0.39 l/day; P < 0.001), respectively. Dietary counseling resulted in a transient reduction of sodium excretion by 19 mmol/day during the first 4 months (P = 0.016) but resulted in a more sustained reduction in urea excretion by 69 mmol/day (P = 0.008). CONCLUSION:Both sodium and urea excretion rates contribute significantly to daily urine volume in patients treated with tolvaptan, and a single session of dietary counseling was transiently effective in reducing sodium intake but achieved a more sustained reduction in protein intake. Dietary counseling should be considered in the management of ADPKD patients treated by tolvaptan.

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BACKGROUND & AIMS: :The authors wish to make a correction to Section 2 [...].

背景与目标： : 作者希望对第2节进行更正 [...]。

BACKGROUND & AIMS: BACKGROUND:A 24 year-old woman with atopic dermatitis occasionally developed symptoms, including dyspnea and generalized urticaria, following ingestion of food containing cows milk. Similar episodes had continued, and had been treated empirically since the age of 16 years. CASE SUMMARY:Although a skin test and IgE RAST showed positive reactions to cows milk, a provocation test with cows milk alone did not induce any symptoms. Therefore, food-dependent exercise-induced anaphylaxis (FDEIA) was suspected, but examination using various combinations of cows milk, aspirin and exercise failed to elicit any symptoms. Finally, a provocation test during the ovulatory phase with cows milk followed by aspirin and exercise evoked systemic urticaria, dyspnea and hypotension. DISCUSSION:The symptoms against cows milk began when she took baths with bath salts containing cows milk as its main ingredient for one year at the age 15 years. Sensitization to cows milk through eczematous skin is indicated from this history. Hormonal change during a premenstrual or ovulatory phase is also an important factor for the development of FDEIA in this case.

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BACKGROUND & AIMS: BACKGROUND:Implantable cardioverter-defibrillators (ICDs) are effective for primary and secondary prevention of sudden cardiac death due to ventricular arrhythmias. However, despite wide clinical use, there are no generally accepted standardized protocols to characterize and report the output capabilities of ICDs. OBJECTIVE:The objective of this study was to measure and compare the output characteristics of standard-output and high-output ICDs from several manufacturers under a common set of conditions. METHODS:The output characteristics of ICDs randomly selected from hospital stock were measured. The energy delivered for each shock to a range of fixed loads (25-75 Omega) was computed from the voltage waveform and the corresponding load. RESULTS:Delivered energy varied by approximately 4 J over the range of loads tested and varied between devices (high-output 33.8-35 J; standard-output 26.7-28.6 J, at 50 Omega). Leading-edge voltage varied by approximately 6% over the range of loads tested and varied between devices (high-output 738-792 V; standard-output 593-797 V, at 50 Omega). Pulse width varied by a factor of approximately 3 over the range of loads tested and varied between devices (high-output 10-14.5 ms; standard-output 9-12.2 ms, at 50 Omega). Observed variations between devices and with load were significant (P <.001). CONCLUSIONS:Potentially important differences in output characteristics of different ICD systems exist and merit further clinical investigation. The reporting of ICD output characteristics should be standardized. Additionally, it is recommended that manufacturers report output characteristics as a function of load over the typical range of patient loads clinically encountered.

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BACKGROUND & AIMS: BACKGROUND/OBJECTIVES:Previous studies have suggested that milk consumption during pregnancy may have growth-promoting effects on the offspring in utero. Whether this effect tracks beyond the prenatal period remains unclear. We examined whether milk consumption during pregnancy is associated with infant size at birth and offspring's height- and growth-related biomarkers at ∼20 years of age. SUBJECT/METHODS:A prospective cohort of 809 Danish pregnant women was recruited in 1988-1989, with offspring follow-up at ∼20 years of age (n=685). Milk consumption was assessed at gestational week 30 using a food frequency questionnaire. Birth weight and birth length were measured according to standard procedures at delivery and converted to specific z-scores, adjusted for gestational age and gender. RESULTS:In adjusted models, maternal milk consumption of ≥150 ml/day vs <150 ml/day was associated with 0.32 higher z-scores for birth weight (95% confidence interval (CI) 0.06; 0.58) and 0.34 higher z-scores for birth length (95% CI 0.04; 0.64). At follow up, ∼20 years later, those offspring whose mothers had consumed < 150 ml milk/day tended to have 0.19 higher z-scores for height (P=0.16), ∼8% higher levels of insulin-like growth factor I (P=0.12) and ∼14% higher insulin levels (P=0.11) compared with offspring whose mothers consumed <150 ml milk/day. CONCLUSIONS:Our findings add to recent observations that maternal milk consumption may have a growth-promoting effect with respect to weight and length at birth. Furthermore, the results provide some suggestion that this effect may even track into early adult age, although further studies with more statistical power are needed for that purpose.

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